DESCRIPTION: (Provided by the Applicant) Context: Disparities in health care access, outcomes and quality are well documented for several racial and ethnic groups. These disparities may be due to the interaction of patient, provider, and system-related factors; however the relative contribution of each is unclear. Changing immigration patterns create a need to assess health disparities in newly emerging, growing groups such as African immigrants and refugees. Cultural competencies, derived from an understanding of patient, provider and systems factors and mechanisms of how they operate, show promise for improving health disparities in maternal health. Goals: To identify specific cultural competency techniques to improve the quality of maternal health care and birth outcomes through the analysis of the relative contribution of patient, clinician, and institutional-related factors to health disparities in African (specifically Somali) women. Participants and Setting: 150-200 community Somali women in Boston, MA. Study Design: (1) Qualitative methods (focus groups and individual semi-structured interviews) to assess Somali women's experiences and beliefs about maternity care in the US and their perception of ways to improve access to and quality of these services; (2) Survey methods for administration of a tool to prioritize which cultural competency techniques or activities Somali women perceive most effective in improving quality of care and birth outcomes. Analysis: Analysis of qualitative material according to Grounded Theory technique. Survey data analyzed using chisquare, correlation, and regression modeling depending on nature of collected information. Significance/Future Directions: We expect that the successful accomplishment of this study will provide new information about the sources of racial and ethnic disparities in maternity care and about potential interventions to address them. The study is part of a planned series to prospectively evaluate the effects of a multi-level intervention on the health outcomes of African women.